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Ishii-Kitano N, Enomoto H, Nishimura T, Aizawa N, Shibata Y, Higashiura A, Takashima T, Ikeda N, Yuri Y, Fujiwara A, Yoshihara K, Yoshioka R, Kawata S, Ota S, Nakano R, Shiomi H, Hirota S, Kumabe T, Nakashima O, Iijima H. Multiple Inflammatory Pseudotumors of the Liver Demonstrating Spontaneous Regression: A Case Report. Life (Basel) 2022; 12:life12010124. [PMID: 35054517 PMCID: PMC8779591 DOI: 10.3390/life12010124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 11/24/2022] Open
Abstract
Inflammatory pseudotumor (IPT) of the liver is a rare benign disease. IPTs generally develop as solitary nodules, and cases with multiple lesions are uncommon. We herein report a case of multiple IPTs of the liver that spontaneously regressed. A 70-year-old woman with a 10-year history of primary biliary cholangitis and rheumatoid arthritis visited our hospital to receive a periodic medical examination. Abdominal ultrasonography revealed multiple hypoechoic lesions, with a maximum size of 33 mm, in the liver. Contrast-enhanced computed tomography revealed low-attenuation areas in the liver with mild peripheral enhancement at the arterial and portal phases. We first suspected metastatic liver tumors, but fluorodeoxyglucose positron emission tomography, magnetic resonance imaging and contrast-enhanced ultrasonography suggested the tumors to be inconsistent with malignant nodules. A percutaneous biopsy showed shedding of liver cells and abundant fibrosis with infiltration of inflammatory cells. Given these findings, we diagnosed the multiple tumors as IPTs. After careful observation for two months, the tumors almost vanished spontaneously. Physicians should avoid a hasty diagnosis of multiple tumors based solely on a few clinical findings, and a careful assessment with various imaging modalities should be conducted.
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Affiliation(s)
- Noriko Ishii-Kitano
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan; (N.I.-K.); (T.N.); (N.A.); (T.T.); (N.I.); (Y.Y.); (A.F.); (K.Y.); (R.Y.); (S.K.); (S.O.); (R.N.); (H.S.); (H.I.)
| | - Hirayuki Enomoto
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan; (N.I.-K.); (T.N.); (N.A.); (T.T.); (N.I.); (Y.Y.); (A.F.); (K.Y.); (R.Y.); (S.K.); (S.O.); (R.N.); (H.S.); (H.I.)
- Correspondence:
| | - Takashi Nishimura
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan; (N.I.-K.); (T.N.); (N.A.); (T.T.); (N.I.); (Y.Y.); (A.F.); (K.Y.); (R.Y.); (S.K.); (S.O.); (R.N.); (H.S.); (H.I.)
- Ultrasound Imaging Center, Hyogo College of Medicine, Nishinomiya 663-8501, Hyogo, Japan; (Y.S.); (A.H.)
| | - Nobuhiro Aizawa
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan; (N.I.-K.); (T.N.); (N.A.); (T.T.); (N.I.); (Y.Y.); (A.F.); (K.Y.); (R.Y.); (S.K.); (S.O.); (R.N.); (H.S.); (H.I.)
| | - Yoko Shibata
- Ultrasound Imaging Center, Hyogo College of Medicine, Nishinomiya 663-8501, Hyogo, Japan; (Y.S.); (A.H.)
| | - Akiko Higashiura
- Ultrasound Imaging Center, Hyogo College of Medicine, Nishinomiya 663-8501, Hyogo, Japan; (Y.S.); (A.H.)
| | - Tomoyuki Takashima
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan; (N.I.-K.); (T.N.); (N.A.); (T.T.); (N.I.); (Y.Y.); (A.F.); (K.Y.); (R.Y.); (S.K.); (S.O.); (R.N.); (H.S.); (H.I.)
| | - Naoto Ikeda
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan; (N.I.-K.); (T.N.); (N.A.); (T.T.); (N.I.); (Y.Y.); (A.F.); (K.Y.); (R.Y.); (S.K.); (S.O.); (R.N.); (H.S.); (H.I.)
| | - Yukihisa Yuri
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan; (N.I.-K.); (T.N.); (N.A.); (T.T.); (N.I.); (Y.Y.); (A.F.); (K.Y.); (R.Y.); (S.K.); (S.O.); (R.N.); (H.S.); (H.I.)
| | - Aoi Fujiwara
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan; (N.I.-K.); (T.N.); (N.A.); (T.T.); (N.I.); (Y.Y.); (A.F.); (K.Y.); (R.Y.); (S.K.); (S.O.); (R.N.); (H.S.); (H.I.)
| | - Kohei Yoshihara
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan; (N.I.-K.); (T.N.); (N.A.); (T.T.); (N.I.); (Y.Y.); (A.F.); (K.Y.); (R.Y.); (S.K.); (S.O.); (R.N.); (H.S.); (H.I.)
| | - Ryota Yoshioka
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan; (N.I.-K.); (T.N.); (N.A.); (T.T.); (N.I.); (Y.Y.); (A.F.); (K.Y.); (R.Y.); (S.K.); (S.O.); (R.N.); (H.S.); (H.I.)
| | - Shoki Kawata
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan; (N.I.-K.); (T.N.); (N.A.); (T.T.); (N.I.); (Y.Y.); (A.F.); (K.Y.); (R.Y.); (S.K.); (S.O.); (R.N.); (H.S.); (H.I.)
| | - Shogo Ota
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan; (N.I.-K.); (T.N.); (N.A.); (T.T.); (N.I.); (Y.Y.); (A.F.); (K.Y.); (R.Y.); (S.K.); (S.O.); (R.N.); (H.S.); (H.I.)
| | - Ryota Nakano
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan; (N.I.-K.); (T.N.); (N.A.); (T.T.); (N.I.); (Y.Y.); (A.F.); (K.Y.); (R.Y.); (S.K.); (S.O.); (R.N.); (H.S.); (H.I.)
| | - Hideyuki Shiomi
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan; (N.I.-K.); (T.N.); (N.A.); (T.T.); (N.I.); (Y.Y.); (A.F.); (K.Y.); (R.Y.); (S.K.); (S.O.); (R.N.); (H.S.); (H.I.)
| | - Seiichi Hirota
- Department of Surgical Pathology, Hyogo College of Medicine, Nishinomiya 663-8501, Hyogo, Japan;
| | | | - Osamu Nakashima
- Department of Clinical Laboratory Medicine, Kurume University Hospital, Kurume 830-0011, Fukuoka, Japan;
| | - Hiroko Iijima
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan; (N.I.-K.); (T.N.); (N.A.); (T.T.); (N.I.); (Y.Y.); (A.F.); (K.Y.); (R.Y.); (S.K.); (S.O.); (R.N.); (H.S.); (H.I.)
- Ultrasound Imaging Center, Hyogo College of Medicine, Nishinomiya 663-8501, Hyogo, Japan; (Y.S.); (A.H.)
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Hamzaoui L, Medhioub M, Mahmoudi M, Chelbi E, Bouzaidi K, Msadak Azouz M. Inflammatory pseudotumor of the liver. Presse Med 2016; 45:804-7. [PMID: 27476013 DOI: 10.1016/j.lpm.2016.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 05/24/2016] [Accepted: 06/16/2016] [Indexed: 11/16/2022] Open
Affiliation(s)
- Lamine Hamzaoui
- Hôpital Mohamed Tahar Maamouri, service de gastroentérologie, Nabeul, Tunisia; Université Tunis-El Manar, faculté de médecine de Tunis, Tunis, Tunisia.
| | - Mouna Medhioub
- Hôpital Mohamed Tahar Maamouri, service de gastroentérologie, Nabeul, Tunisia; Université Tunis-El Manar, faculté de médecine de Tunis, Tunis, Tunisia
| | - Moufida Mahmoudi
- Hôpital Mohamed Tahar Maamouri, service de gastroentérologie, Nabeul, Tunisia; Université Tunis-El Manar, faculté de médecine de Tunis, Tunis, Tunisia
| | - Emna Chelbi
- Hôpital Mohamed Tahar Maamouri, service d'anatomopathologie, Nabeul, Tunisia; Université Tunis-El Manar, faculté de médecine de Tunis, Tunis, Tunisia
| | - Khaled Bouzaidi
- Hôpital Mohamed Tahar Maamouri, service de radiologie, Nabeul, Tunisia; Université Tunis-El Manar, faculté de médecine de Tunis, Tunis, Tunisia
| | - Mohamed Msadak Azouz
- Hôpital Mohamed Tahar Maamouri, service de gastroentérologie, Nabeul, Tunisia; Université Tunis-El Manar, faculté de médecine de Tunis, Tunis, Tunisia
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Obana T, Yamasaki S, Nishio K, Kobayashi Y. A case of hepatic inflammatory pseudotumor protruding from the liver surface. Clin J Gastroenterol 2015; 8:340-4. [PMID: 26412330 DOI: 10.1007/s12328-015-0605-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 09/05/2015] [Indexed: 12/17/2022]
Abstract
We report a case of a resected hepatic inflammatory pseudotumor (IPT) protruding from the liver surface. A 69-year-old male with diabetes mellitus was admitted to hospital for investigation of an hepatic mass. An irregularly shaped, low-echoic mass measuring 21 × 18 mm was identified by ultrasound in S6. On computed tomography, the tumor appeared to be growing extrahepatically. After contrast enhancement, the lesion showed persistent peripheral enhancement, while the central part was hypoenhanced. On T2-weighted magnetic resonance imaging (MRI), the central portion of the lesion was hyperintense compared with the periphery. EOB-enhanced MRI revealed the mass to be being hypointense in contrast to the surrounding liver parenchyma in the hepatobiliary phase. On diffusion-weighted images, the lesion was hyperintense. Percutaneous biopsy was not attempted to avoid tumor cell dissemination. The patient underwent partial hepatectomy because of suspected malignancy. Histopathological examination of the resected specimen revealed fibrotic tissue and abundant vessels in the periphery, while a massive infiltration of inflammatory cells and fewer vessels were observed in the center. The patient was finally diagnosed with hepatic IPT of the fibrohistiocytic type.
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Affiliation(s)
- Takashi Obana
- Department of Gastroenterology, Kyojinkai Komatsu Hospital, 11-6 Kawakatsu-cho, Neyagawa City, Osaka Prefecture, 572-8567, Japan.
| | - Shuuji Yamasaki
- Department of Gastroenterology, Kyojinkai Komatsu Hospital, 11-6 Kawakatsu-cho, Neyagawa City, Osaka Prefecture, 572-8567, Japan
| | - Kazushi Nishio
- Department of Surgery, Kyojinkai Komatsu Hospital, Neyagawa, Japan
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Al-Hussaini H, Azouz H, Abu-Zaid A. Hepatic inflammatory pseudotumor presenting in an 8-year-old boy: A case report and review of literature. World J Gastroenterol 2015; 21:8730-8738. [PMID: 26229415 PMCID: PMC4515854 DOI: 10.3748/wjg.v21.i28.8730] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/27/2015] [Accepted: 03/31/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatic inflammatory pseudotumors are uncommon benign lesions. Accurately diagnosing hepatic inflammatory pseudotumor can be very challenging because the clinical presentation and radiological appearances are nonspecific and cannot be certainly distinguished from malignant neoplastic processes. Herein, we present a case of hepatic IPT in an 8-year-old boy who presented to clinic with a 3-mo history of a tender hepatic mass, fever of unknown origin, and 9-kg weight loss. The physical examination was notable for tender hepatomegaly. Laboratory investigations were notable for a normal hepatic profile and elevated erythrocyte sedimentation rate and C-reactive protein. A T2-attenuated magnetic resonance imaging scan of the abdomen showed a 4.7 cm × 4.7 cm × 6.6 cm, contrast-enhancing, hyper-intense, well-defined lesion involving the right hepatic lobe. In view of the unremitting symptoms, tender hepatomegaly, thrombosed right hepatic vein, nonspecific radiological findings, and high suspicion of a deep-seated underlying infection or malignancy, a right hepatic lobectomy was recommended. Microscopically, the hepatic lesion exhibited a mixture of inflammatory cells (histiocytes, plasma cells, mature lymphocytes, and occasional multinucleated giant cells) in a background of dense fibrous tissue. Immunohistochemically, the cells stained negative for SMA, ALK-1, CD-21 and CD-23, diffusely positive for CD-68, and focally positive for IgG4. The final histopathological diagnosis was consistent with hepatic IPT. At the postoperative 4-mo follow-up, the patient was asymptomatic without radiological evidence of recurrence.
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Roux M, Baranes L, Decaens T, Cherqui D, Nhieu JTV, Pigneur F, Djabbari M, Levy M, Laurent A, Rahmouni A, Luciani A. Recurring multicystic inflammatory pseudotumor of the liver: a case report. Clin Res Hepatol Gastroenterol 2013; 37:e51-7. [PMID: 23219424 DOI: 10.1016/j.clinre.2012.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 08/23/2012] [Accepted: 08/29/2012] [Indexed: 02/04/2023]
Abstract
Inflammatory pseudotumor (IPT) of the liver is a rare benign lesion for which imaging diagnosis remains a challenge. We report the case of a 39-year-old Algerian woman, who presented epigastric pains combined with fever and jaundice. Ultrasound, CT scan and MRI showed the presence of a 10 cm-long multi-septated cystic mass of the left lobe, with peripheral enhancement. A left-hepatectomy was performed and histopathology revealed an IPT of the liver. During the 4 following years, the patient had three other recurrences of liver IPT at various locations distinct from the original, revealed by the same clinical symptoms. During these relapses, the lesions did regress thanks to a medical treatment. This observation underlines the difficulty of the diagnosis and treatment of liver IPT.
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Affiliation(s)
- Marion Roux
- AP-HP, Groupe Henri-Mondor Albert-Chenevier, Radiology department, 51, Avenue du Marechal-de-Lattre de Tassigny, 94010 Créteil, France.
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